Collins Claire, Doran Gillian, Patton Patricia, Fitzgerald Roisin, Rochfort Andree
Director of Research, Irish College of General Practitioners, Dublin, Ireland
Head Librarian, Irish College of General Practitioners, Dublin, Ireland.
BJGP Open. 2021 Jun 30;5(3). doi: 10.3399/BJGPO.2020.0186. Print 2021 Jun.
Primary care has a vital role in supporting patient autonomy to enable people with long-term conditions to manage their own health and wellness. Evidence is needed on whether education and training of health professionals helps support patient self-management and improves outcomes. The authors' first systematic review included only two articles showing patient outcomes following health professional training for promoting patient self-management.
To present an updated review undertaken from September 2013 to August 2018.
DESIGN & SETTING: A systematic review was undertaken using the PRISMA guidelines, following the methodology of the first review and is outlined in the PROSPERO registered protocol.
Six databases were searched - Cochrane Library, PubMed, ERIC, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO - in addition to web searches, hand searches, and bibliographies for articles published from 1 September 2013 to 31 August 2018.
The updated systematic review showed more evidence is now available with 18 articles in the 5-year period from the 4284 abstracts located. Twelve of these articles showed a difference between intervention and control groups. Of the 18 articles identified, 11 were assessed as having a low risk of bias and five overall were rated of weak quality. The educational interventions with health professionals spanned a range of techniques and modalities, and many incorporated multiple interventions including patient components. There may be a lack of adoption owing to several challenges, including that complex interventions may not be delivered as planned and are difficult to assess, and owing to patient engagement and the need for ongoing follow-up.
More high-quality research is needed on what methods work best, for which patients, and for what clinical conditions in the primary care setting. The practical implications of training healthcare professionals require specific attention.
初级保健在支持患者自主性方面发挥着至关重要的作用，使患有长期疾病的人能够管理自己的健康状况。目前需要证据来证明对卫生专业人员的教育和培训是否有助于支持患者自我管理并改善治疗效果。作者的首次系统评价仅纳入了两篇显示卫生专业人员接受促进患者自我管理培训后患者治疗效果的文章。
呈现2013年9月至2018年8月进行的更新评价。
按照首次评价的方法，采用PRISMA指南进行系统评价，并在PROSPERO注册方案中进行了概述。
除了网络搜索、手工检索和参考文献检索外，还检索了六个数据库——Cochrane图书馆、PubMed、教育资源信息中心（ERIC）、Embase、护理及相关健康文献累积索引（CINAHL）和心理学文摘数据库（PsycINFO），以查找2013年9月1日至2018年8月31日发表的文章。
更新后的系统评价显示，从检索到的4284篇摘要中，在这5年期间有18篇文章提供了更多证据。其中12篇文章显示干预组和对照组之间存在差异。在确定的18篇文章中，11篇被评估为偏倚风险较低，总体上有5篇质量较弱。针对卫生专业人员的教育干预涵盖了一系列技术和方式，许多干预措施包含多种干预手段，包括患者相关内容。由于存在一些挑战，可能缺乏采用，包括复杂的干预措施可能无法按计划实施且难以评估，以及患者参与度和持续随访的需求。
在初级保健环境中，对于哪些方法对哪些患者以及哪些临床情况最有效，需要进行更多高质量的研究。培训医疗保健专业人员的实际意义需要特别关注。
